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      Digital Cervicography by Simply Portable Device as an Alternative Test for Cervical Cancer Screening in Rural Area of Thailand

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          Abstract

          Objective:

          Various screening methods for cervical cancer are proved to be effective in reducing such type of cancer. We aims to introduce a new portable device as an alternative method for cervical cancer screening. The performance of device was tested on the assessment of cervical lesions using cervicograph score with the cervical cytology.

          Methods:

          325 non-pregnant women were tested from March 2013 to August 2015. The cervical and vaginal cells from the sample were collected for cytology, then all of them received the digital cervicography conducted with our new device and scored using cervicograph score. Small pieces of cervical tissues were also collected for histologic examination. SPSS software version 18.0 was used for the statistical analysis.

          Results:

          We grouped cytology results and cervicograph scores to 2 subgroups, ≤ ASC-US and ≥ LSIL, and 0-3 points and 4-6 points, respectively. The data then correlated with histology results which sub-grouped to ≤ CIN 1 and ≥ CIN 2. The accuracy, sensitivity, specificity, and positive predictive value (PPV) of cervicograph scores 4-6 points to detect CIN 2+ were 92%, 72.41%, 97%, and 84%, respectively which were not inferior to Pap smear did.

          Conclusion:

          The digital cervicography device provides similar accuracy to Pap cytology screening and is suitable to use in the area that lacks cytoscreeners. Large scale use and generalization are required for this new device.

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          Most cited references19

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          Genital warts and cervical cancer. VII. An improved colposcopic index for differentiating benign papillomaviral infections from high-grade cervical intraepithelial neoplasia.

          A new colposcopic sign (sharpness of peripheral margins) was graded into three objective categories representing subclinical papillomaviral infection, lower grade dysplasia, and grade 3 cervical intraepithelial neoplasia. Colposcopic features were prospectively recorded in 72 women and then correlated with histologic findings. Histologic diagnoses were evenly spread within the disease spectrum: 18 patients had subclinical papillomaviral infection without associated dysplasia; 15 had grade 1, 16 had grade 2, and 23 had grade 3 cervical intraepithelial neoplasia with or without koilocytotic atypia. Differences in the pattern of the peripheral margin were discriminatory throughout the entire diagnostic range. Predictive accuracy of this new colposcopic sign (79%) compared favorably with that of color (72%), vascular atypia (81%), and iodine staining (72%). Each criterion was independent of the other three. Hence, combining these four individual signs into a colposcopic index was 97% correct in forecasting approximate histologic findings. Because formulation of the colposcopic index is based on critical analysis rather than pattern recall, the use of this method will greatly simplify the otherwise arduous task of learning colposcopy.
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            Cervical cancer screening: Safety, acceptability, and feasibility of a single-visit approach in Bulawayo, Zimbabwe

            Background Cervical cancer is the commonest cancer amongst African women, and yet preventative services are often inadequate. Aim The purpose of the study was to assess the safety, acceptability and feasibility of visual inspection with acetic acid and cervicography (VIAC) followed by cryotherapy or a loop electrical excision procedure (LEEP) at a single visit for prevention of cancer of the cervix. Setting The United Bulawayo Hospital, Zimbabwe. Methods The study was descriptive, using retrospective data extracted from electronic medical records of women attending the VIAC clinic. Over 24 months 4641 women visited the clinic and were screened for cervical cancer using VIAC. Cryotherapy or LEEP was offered immediately to those that screened positive. Treated women were followed up at three months and one year. Results The rate of positive results on VIAC testing was 10.8%. Of those who were eligible, 17.0% received immediate cryotherapy, 44.1% received immediate LEEP, 1.9% delayed treatment, and 37.0% were referred to a gynaecologist. No major complications were recorded after cryotherapy or LEEP. Amongst those treated 99.5% expressed satisfaction with their experience. Only 3.2% of those treated at the clinic had a positive result on VIAC one year later. The service was shown to be feasible to sustain over time with the necessary consumables. There were no service-related treatment postponements and the clinic staff and facility were able to meet the demand for the service. Conclusion A single-visit approach using VIAC, followed by cryotherapy or LEEP, proved to be safe, acceptable and feasible in an urban African setting in Bulawayo, Zimbabwe. Outcomes a year later suggested that treatment had been effective.
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              Prediction of cervical histologic results using an abbreviated Reid Colposcopic Index during ALTS.

              The purpose of this study was to determine the accuracy of an abbreviated Reid Colposcopic Index (RCI) to detect cervical intraepithelial neoplasia (CIN) 2 and CIN 3 during the National Cancer Institute (NCI) ASCUS LSIL Triage Study (ALTS). Colposcopists from 4 ALTS clinical centers indicated an RCI score after colposcopically examining subjects. Colposcopy quality control reviewers also documented an RCI score for the same subjects after assessing their digitized cervical images. Associations of colposcopist and reviewer RCI scores with histologic results were evaluated. Agreement rates between colposcopists and reviewers were calculated for colposcopic impression. Overall RCI score agreement was poor (weighted Kappa = 0.17). The sensitivity, specificity, positive and negative predictive values of a colposcopist's RCI score of >3/6 to detect CIN 3 or worse were 37.3% (95% CI 32.5%-42.3%), 89.7% (88.6%-90.8%), 30.8% (26.7%-35.2%), and 92.1% (91.1%-93.0%), respectively. The 3 colposcopic signs were not individually sensitive in detecting CIN 3. Colposcopists using the RCI in the ALTS trial failed to detect CIN 2/3 at the levels expected.
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                Author and article information

                Journal
                Asian Pac J Cancer Prev
                Asian Pac. J. Cancer Prev
                Asian Pacific Journal of Cancer Prevention : APJCP
                West Asia Organization for Cancer Prevention (Iran )
                1513-7368
                2476-762X
                2018
                : 19
                : 4
                : 1145-1149
                Affiliations
                [1 ] Obstetrician-Gynecologist, Bangmunnak Hospital, Phichit province, Bangkok, Thailand
                [2 ] Obstetrics-Gynecology Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
                Author notes
                [* ] For Correspondence: chaopotong@ 123456gmail.com
                Article
                APJCP-19-1145
                10.22034/APJCP.2018.19.4.1145
                6031769
                29699376
                9adee9e6-a89e-44a1-81d0-31c98c0970bb
                Copyright: © Asian Pacific Journal of Cancer Prevention

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                : 18 January 2018
                : 09 March 2018
                Categories
                Research Article

                alternative test,cervical cancer,screening,cervicography,rural area

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